糖尿病痛苦在老年T2DM患者抑郁症状与自我效能间的中介效应研究

李莎莎; 黄依璇; 黄安莉; 罗智花; 许敏; 曹秀菁

doi:10.16462/j.cnki.zhjbkz.2022.05.004

糖尿病痛苦在老年T2DM患者抑郁症状与自我效能间的中介效应研究

doi: 10.16462/j.cnki.zhjbkz.2022.05.004

1.
230032 合肥，安徽医科大学公共卫生学院儿少卫生与妇幼保健学
2.
230032 合肥，安徽医科大学第一临床医学院临床医学(“5+3”一体化)专业
3.
246052 安庆，安庆医药高等专科学校护理学院
4.
230022 合肥，安徽医科大学第一附属医院儿科
5.
230022 合肥，安徽医科大学第一附属医院内分泌科

基金项目:

省级质量工程教学研究项目 2020jyxm0614

安徽医科大学基础与临床合作研究提升计划 2020xkjT035

详细信息

通讯作者:
曹秀菁，E-mail: xiujingcao@yeah.net

中图分类号: R587.1
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- PDF下载量: 96
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-21
- 修回日期: 2022-02-12
- 网络出版日期: 2022-05-11
- 刊出日期: 2022-05-10

The mediating effect of diabetic distress on depressive symptoms and self-efficacy in elderly patients with T2DM

1.
Department of Pediatric Health and Maternal and Child Health, School of Public Health, Anhui Medical University, Hefei 230032, China
2.
Department of Clinical Medicine, The First School of Clinical Medicine, Anhui Medical University, Hefei 230032, China
3.
Nursing College, Anqing Medical College, Anqing 246052, China
4.
Department of Pediatric, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China
5.
Department of Endocrinology, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China

Funds:

Provincial Quality Engineering Teaching Research Project 2020jyxm0614

Basic and Clinical Cooperative Research promotion Program of Anhui Medical University 2020xkjT035

More Information

Corresponding author: CAO Xiu-jing, E-mail: xiujingcao@yeah.net

摘要

摘要: 目的探讨抑郁症状对社区老年2型糖尿病患者(type 2 diabetes mellitus, T2DM)自我效能的影响，以及糖尿病痛苦在其中的中介作用。方法采用便利抽样的方式对某社区服务管理中心的248名老年T2DM患者进行问卷调查。同时收集一般人口学特征、糖尿病相关信息、自我效能、抑郁症状和糖尿病痛苦情况。多元线性回归分析模型分析抑郁症状对自我效能的影响，Bootstrap法进行中介分析。结果抑郁症状(β=-0.272, P < 0.01)和糖尿病痛苦(β=-0.345, P < 0.01)是自我效能的影响因素，糖尿病痛苦在抑郁症状与自我效能之间具有中介作用(Boot CI: -2.460 2~-0.783 9, P < 0.05)。结论情绪障碍的改善有利于社区老年T2DM患者自我效能水平的提高。
- 2型糖尿病 /
- 自我效能 /
- 抑郁症状 /
- 糖尿病痛苦
Abstract: Objective To explore the influence of depression on self-efficacy in elderly patients with type 2 diabetes mellitus (T2DM) in the community and the mediating role of diabetic distress. Methods By convenience sampling, the 248 elderly T2DM patients managed by a community service center were investigated with questionnaire. The general demographic characteristics, diabetes-related information, self-efficacy, depression, and diabetic distress were collected. Multiple linear regression model was used to analyze the influence of depression on self-efficacy, and Bootstrap method was used for mediation analysis. Result Depression (β=-0.272, P < 0.01) and diabetes distress (β=-0.345, P < 0.01) were associated risk factors of self-efficacy, and diabetes distress played a mediating role between depression and self-efficacy (Boot CI: -2.460 2~-0.783 9, P < 0.05). Conclusion An important way to enhance the level of self-efficacy of elderly patients with T2DM in the community may be improving emotional disorder.
- Type 2 diabetes mellitus /
- Self-efficacy /
- Depression /
- Diabetes distress

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表 1 某社区老年糖尿病患者基本特征与自我效能的分布情况[n(%)]

Table 1. Distribution of basic characteristics and self-efficacy of elderly diabetes patients in a community [n(%)]

变量	N(%)	自我效能		χ²值	P值	变量	N(%)	自我效能		χ²值	P值
变量	N(%)	高水平	中等及以下水平	χ²值	P值	变量	N(%)	高水平	中等及以下水平	χ²值	P值
年龄(岁)				0.525	0.469	糖尿病病程(年)				0.397	0.529
60~＜75	136(54.8)	45(18.1)	91(36.7)			1~≤10	135(54.4)	45(18.1)	90(36.3)
75~≤89	112(45.2)	42(16.9)	70(28.3)			＞10	113(45.6)	42(16.9)	71(28.6)
性别				0.503	0.478	个人糖尿病月花费(元)				0.243	0.886
男	115(46.4)	43(17.3)	72(29.1)			＜200	87(35.1)	32(12.9)	55(22.2)
女	133(53.6)	44(17.7)	89(35.9)			200~≤400	109(44.0)	38(15.3)	71(28.6)
婚姻状态				4.796	0.029 ^a	＞400	52(20.9)	17(6.9)	35(14.2)
在婚	188(75.8)	73(29.4)	115(46.4)			BMI(kg/m²)				5.723	0.017 ^a
未在婚(含丧偶、未婚)	60(24.2)	14(5.6)	46(18.5)			＜24	137(55.2)	52(23.0)	80(32.3)
教育水平				17.239	0.001 ^b	≥24	111(44.8)	30(12.1)	81(32.7)
小学及以下	91(36.7)	19(7.7)	72(29.1)			抑郁症状				334.526	< 0.001 ^b
初中(含未毕业)	85(34.3)	36(14.5)	49(19.8)			无抑郁症状	131(52.8)	68(27.4)	63(25.4)
高中(含未毕业)	41(16.5)	14(5.6)	27(10.9)			有抑郁症状	117(47.2)	19(7.7)	98(39.5)
大学及以上	31(12.5)	18(7.3)	13(5.2)			糖尿病痛苦				9.209	0.010 ^a
家庭月收入(元)				2.144	0.342	中等以下痛苦	144(58.1)	57(23.0)	87(35.1)
＜2 000	38(15.3)	15(6.0)	23(9.3)			中等痛苦	59(23.8)	23(9.3)	36(14.5)
2 000~≤4 000	95(38.3)	28(11.3)	67(27.1)			中等以上痛苦	45(18.1)	7(2.8)	38(15.3)
＞4 000	115(46.4)	44(17.7)	71(28.6)
居住方式				15.628	0.001 ^b
独居	46(18.5)	17(6.9)	29(17.1)
与配偶居住	149(60.1)	62(25.0)	87(35.1)
与子女居住	35(14.1)	7(2.8)	28(11.3)
其他	18(7.3)	1(0.4)	17(6.9)
注：^a表示P < 0.05；^b表示P < 0.01。

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表 2 糖尿病管理自我效能的多元线性回归分析

Table 2. Multiple linear regression analysis of diabetes management self-efficacy

变量	未标准化β值	s_x值	标准化β值	t值	(95% CI)值	P值
常量	233.957	29.844		7.839	175.164~292.749	＜0.001
年龄	-0.146	0.307	-0.025	-0.477	-0.751~0.459	0.634
性别
男(对照)
女	11.958	4.277	0.147	2.796	3.531~20.385	0.006 ^b
文化水平
小学及以下(对照)
初中(含未毕业)	15.222	5.148	0.178	2.957	5.080~25.364	0.003 ^b
高中(含未毕业)	11.585	6.542	0.106	1.771	-1.303~24.473	0.078
大学及以上	17.457	7.402	0.142	2.358	2.875~32.040	0.019 ^a
家庭月收入(元)
＞2 000(对照)
2 000~≤4 000	10.452	6.333	0.125	1.650	-2.024~22.928	0.100
＞4 000	14.357	6.335	0.176	2.266	1.877~26.838	0.024 ^a
BMI	-2.154	0.719	-0.155	-2.994	-3.571~-0.737	0.003 ^b
抑郁症状	-2.868	0.607	-0.272	-4.726	-4.064~-1.673	＜0.001 ^b
糖尿病痛苦	-1.350	0.221	-0.345	-6.108	-1.785~-0.914	＜0.001 ^b
注：^a表示P < 0.05；^b表示P < 0.01。

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表 3 自我效能、抑郁症状和糖尿病痛苦的相关性分析

Table 3. Correlation analysis of self-efficacy, depressive symptoms and diabetic distress

变量	自我效能	抑郁症状	糖尿病痛苦
自我效能	1.000
抑郁症状	-0.480 ^a	1.000
糖尿病痛苦	-0.478 ^a	0.427 ^a	1.000
注：表中数字为r，^a表示P < 0.01。

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表 4 糖尿病痛苦在抑郁症状与自我效能中的中介效应分析

Table 4. Analysis of the mediating effect of diabetic pain on depressive symptoms and self-efficacy

变量	间接效应Boot CI值	间接效应a×b	直接效应Boot CI值	直接效应c’	中介效应比例a×b/c
糖尿病痛苦
模型1	-2.525 3~-0.695 5	-1.500 9	-4.786 7~-2.366 9	-3.576 8	29.56%
模型2	-2.460 2~-0.783 9	-1.472 0	-4.279 1~-1.863 6	-3.071 3	32.40%
注：模型2为控制了年龄、性别、文化水平以及家庭月收入的中介效应模型。

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变量	N(%)	自我效能		χ²值	P值	变量	N(%)	自我效能		χ²值	P值
变量	N(%)	高水平	中等及以下水平	χ²值	P值	变量	N(%)	高水平	中等及以下水平	χ²值	P值
年龄(岁)				0.525	0.469	糖尿病病程(年)				0.397	0.529
60~＜75	136(54.8)	45(18.1)	91(36.7)			1~≤10	135(54.4)	45(18.1)	90(36.3)
75~≤89	112(45.2)	42(16.9)	70(28.3)			＞10	113(45.6)	42(16.9)	71(28.6)
性别				0.503	0.478	个人糖尿病月花费(元)				0.243	0.886
男	115(46.4)	43(17.3)	72(29.1)			＜200	87(35.1)	32(12.9)	55(22.2)
女	133(53.6)	44(17.7)	89(35.9)			200~≤400	109(44.0)	38(15.3)	71(28.6)
婚姻状态				4.796	0.029 ^a	＞400	52(20.9)	17(6.9)	35(14.2)
在婚	188(75.8)	73(29.4)	115(46.4)			BMI(kg/m²)				5.723	0.017 ^a
未在婚(含丧偶、未婚)	60(24.2)	14(5.6)	46(18.5)			＜24	137(55.2)	52(23.0)	80(32.3)
教育水平				17.239	0.001 ^b	≥24	111(44.8)	30(12.1)	81(32.7)
小学及以下	91(36.7)	19(7.7)	72(29.1)			抑郁症状				334.526	< 0.001 ^b
初中(含未毕业)	85(34.3)	36(14.5)	49(19.8)			无抑郁症状	131(52.8)	68(27.4)	63(25.4)
高中(含未毕业)	41(16.5)	14(5.6)	27(10.9)			有抑郁症状	117(47.2)	19(7.7)	98(39.5)
大学及以上	31(12.5)	18(7.3)	13(5.2)			糖尿病痛苦				9.209	0.010 ^a
家庭月收入(元)				2.144	0.342	中等以下痛苦	144(58.1)	57(23.0)	87(35.1)
＜2 000	38(15.3)	15(6.0)	23(9.3)			中等痛苦	59(23.8)	23(9.3)	36(14.5)
2 000~≤4 000	95(38.3)	28(11.3)	67(27.1)			中等以上痛苦	45(18.1)	7(2.8)	38(15.3)
＞4 000	115(46.4)	44(17.7)	71(28.6)
居住方式				15.628	0.001 ^b
独居	46(18.5)	17(6.9)	29(17.1)
与配偶居住	149(60.1)	62(25.0)	87(35.1)
与子女居住	35(14.1)	7(2.8)	28(11.3)
其他	18(7.3)	1(0.4)	17(6.9)
注：^a表示P < 0.05；^b表示P < 0.01。

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糖尿病痛苦在老年T2DM患者抑郁症状与自我效能间的中介效应研究

doi: 10.16462/j.cnki.zhjbkz.2022.05.004

通讯作者:
曹秀菁，E-mail: xiujingcao@yeah.net

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The mediating effect of diabetic distress on depressive symptoms and self-efficacy in elderly patients with T2DM

Corresponding author: CAO Xiu-jing, E-mail: xiujingcao@yeah.net

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糖尿病痛苦在老年T2DM患者抑郁症状与自我效能间的中介效应研究

doi: 10.16462/j.cnki.zhjbkz.2022.05.004

通讯作者: 曹秀菁，E-mail: xiujingcao@yeah.net

计量

出版历程

The mediating effect of diabetic distress on depressive symptoms and self-efficacy in elderly patients with T2DM

Corresponding author: CAO Xiu-jing, E-mail: xiujingcao@yeah.net

计量

出版历程

目录

通讯作者:
曹秀菁，E-mail: xiujingcao@yeah.net